Innovative Healthcare Alternatives

Innovative Healthcare Alternatives

Davenport University

Shyla Allers

Part A

Surgicenter

1. Definition- a surgicenter is a medical healthcare facility that stands alone and does surgical procedures on an outpatient basis. There is no overnight stay required as the procedures are usually elective or lower risk procedures and patients are able to go home after their procedure is completed. It is important to note that Surgicenters can be freestanding but can also be associated with a hospital. One of the main reasons that surgicenters are practical is they tend to offer a lower cost option for patients. It can also be much more efficient in regards to paperwork and actually getting the procedure done sooner which equals less time lost at work. (Frey, 2013)
2. Structure-a surgicenter is neither an emergency facility nor a primary care center. Patients must work through their primary care physician to determine an elective procedure could be done. A referral is done and the specific location that the physician can do the procedure is identified. Surgicenters do not have to be certified by Medicare in order to be accredited by JCAHO.  Surgicenters are classified in some cases by their ownership. Some are hospital owned, “some owned by the physicians who use them and some are by investor-owned businesses.” (Frey, 2013)
3. Financing mechanisms-patients who are receiving care in these outpatient type facilities are able to use their insurance. Medicare reimbursement is based on a fee schedule that was from data in 1986. The approval list of procedures that Medicare will pay is not updated either, so due to technology advancements, what Medicare covers in surgicenters is very behind and has not been updated since 1995.
4. Managed care impact-hospitals are hiring more physicians and hospitalists which give the surgicenter a smaller pool of physicians that are available. The largest areas where surgicenters are located tend to be in more populated areas so the impact is hardest hit in metropolitan areas. Rural areas still rely on community type based hospitals for elective procedures.

Telehomecare

1. Definition-telehomecare is a smaller category within the telehealth area of healthcare. It enables not only to use technology to help the patient, but telehomecare is used in the patient’s home. It allows voice, video and health related data by using the telephone lines. It can also include a computer, wireless device or video camera. Telehomecare also uses physiologic monitoring equipment like a stethoscope, blood pressure cuff, or thermometer. Home care companies are utilizing this type of care for the chronically ill patients, only with adult patients.  This type of telecommunications is a very viable option especially for those patients who are unable to get to doctors offices or clinics. This service also allows for time to reach more patients. (Shea & Chamoff, 2012)
2. Structure-the basis of telehomecare comes from the area of home care. Patients that are discharged from hospitals or other type of inpatient facilities go home and receive a transitional type of care from nurses. A physician will write orders that they would like the patient to receive while under the care of a home health agency. The agency then utilizes nurses to give care to this patient population. With telehomecare, the patient is seen and data is collected through various technologies and that data is transferred to the telehomecare nurse. The computer program being used is also flagging certain values that are out of normal range so that the nurse is able to determine if the patient needs some type of intervention.
3. Financing mechanisms-at this time, the only agency that is receiving reimbursement for this type of primary source of communication for chronically ill patients is the veteran’s health administration.
4. Managed care impact- there could be a huge impact with telehomecare. Within the VHA (veteran’s health administration) it has had a reduction in emergency room visits by 40%, 63% reduction in hospital admissions as well as a 60% reduction in hospital bed days of care. (Shea & Chamoff, 2012)

Day Hospital

1. Definition-A day hospital is a separate facility or an area inside of a hospital that offers services for a type of patient or group of patients like rehabilitation or clinical treatment. These services are provided on a daytime basis and the patient receives treatment for the day and then is able to go home at night. These facilities usually are targeted at the elderly, mentally ill or that have learning disabilities. Another example is treatment for alcoholism. The day hospital is a viable option mainly to allow the patient the comfort of being at home in the evenings but still receive necessary treatment during the day. It also takes away the stigma of being institutionalized in the case psychiatric care.
2. Structure- community health services is responsible for most of the mental health type programs. These day hospitals can be serviced by community mental health teams, local agencies and community, as well as family physicians and various public and private institutions. (Curral, Lopes, Norton, Roma-Torres, 2014)
3. Financing mechanisms-the majority of facilities take insurance and private pay. Most of the funding however is through Medicare and Medicaid. Day hospitals that are affiliated or even located within hospitals will have an indigent type fund to help cover costs for those unable to pay or without insurance.
4. Managed care impact-the impact for day hospitals on managed care is significant. The day hospitals reduce ED visits which translates into cost savings for a hospital. Because of the reduction from managed care in the reimbursement process, it is a can be reimbursed great tool to be able to offer an alternative treatment option at a reduced cost.

Hospital at Home

1. Definition-hospital at home is a care model that provides hospital-level care in a patient’s home. This type of model is a substitute for acute care. This model was developed for older adults and is a viable option to help reduce costs, improve patient safety, quality and satisfaction.
2. Structure-using certain criteria, physicians will identify patients who meet the criteria and offer the option to the patient. The patient is then transported home and is visited at least once or more per day from nurses as well as physicians.
3. Financing mechanisms-the hospital at home model is funded by a grant, but the services provided by the nurses and physicians are pay for fee services. They are currently working on a bundled payment model.
4. Managed care impact-the impact and benefit of this service could be huge! The reduction in hospital admissions, and most importantly the reduction in spread of viruses and infection within the hospital setting can save a very large amount of money to hospitals.

Part B

1. How has the insurgence of each of these healthcare alternatives financially impacted hospitals? With all the varied options out there for healthcare needs, it seems that the competition between certain types of care would lower healthcare costs as a whole. However, according to the Congressional Budget Office, they are not able to define any financial gains from such competition. (Dayaratna, 2013) there has been a big push for value-based payment systems which encourages consumers to be more cost conscious. This leads patients to compare costs and look to some of these other healthcare alternatives for savings which in turn hurts the hospitals bottom line.
2. Do they allow better management of current demand? Are they alternatives to hospital care or do they simply increase healthcare activity? In the past there has been a reduction in necessary hospital beds because of different alternatives available to patients. There is still a high demand; it has just shifted with various technologies and alternatives. It is merely increasing healthcare activity because of the aging population and high demand for care. (Anderson, 2014)
3. Is the result a more cost effective health service, a higher quality service, or both-or neither? These healthcare alternatives in my mind offer both cost effective health service as well as a higher quality service. With the different options out there creating competition, healthcare costs can eventually be driven down. Another aspect to the cost effectiveness is that many of the alternatives are much cheaper, even though there are some services that indeed cost more than a hospital. A high quality service is something every patient wants and with alternatives that give more one on one patient centered care, the quality of care increases in the patients eyes. It is a win-win situation. (Drexler, 2010)

Conclusion

While the full extent of cost savings has not been realized in our society with regards to the innovative healthcare alternatives previous mentioned, the quality and satisfaction from patients continues to offer hope. If our nation continues to stay open to looking at various alternatives to standards that were set decades before, we can only improve the effectiveness and cost of healthcare in America.